胎儿超声心动图检查的多中心临床评价

目的 评价高危人群中进行胎儿超声心动图检查的诊断价值。方法 2003年1月至2004年12月,在上海两家三级妇产科医院进行高危人群中胎儿先天性心脏病产前诊断前瞻性研究。运用二维和彩色／脉冲多普勒超声进行详细化胎儿超声心动图检查,随访并评价诊断灵敏度、特异度及患儿预后。结果研究期间共2063例胎儿接受检查,检查时平均孕周为26,5周（16—42周）。产前诊断胎儿先天性心脏病43例,诊断时平均孕周27．3周（16—40周）,异常病例检查指征中“产科超声检查发现胎儿心脏可疑异常”占67．4％。产前诊断灵敏度92.1％,特异度99．9％。准确性86．1％。随访病例中,52．1％终止妊娠,2．2％宫内死亡,13％新生儿或婴儿期死亡,28．3％存活。结论（1）目前临床实践中胎儿超声心动图检查是在高危人群中进行先天性心脏病产前诊断的有效方法。（2）产科超声筛查提示胎儿心脏畸形是检查的重要指征。（3）完整的分段诊断是提高诊断准确性的关键。（4）患有先天性心脏病的胎儿预后不佳,由产科与儿科医生参与的多学科合作可能有助于改善胎儿预后。

Fetal echocardiography in diagnosing congenital heart disease prenatally: a multicenter clinical study

Objective To evaluate the detection and accuracy of fetal echocardiography for congenital heart defects among high-risk populations.Methods A prospective observational study of prenatal diagnosis of congenital heart disease was conducted in two tertiary obstetrics and gynecology hospitals between January 2003 and December 2004.Consecutive fetuses at risk of congenital heart disease underwent detailed fetal echocardiography during the study period.B-mode and colour/pulsed Doppler flow imaging were used in all cases.Follow-up was sought for all pregnancies.Indications for referral,maternal and gestational age at diagnosis,as well as prenatal and postnatal diagnosis were recorded prospectively.By comparing prenatal and postnatal diagnoses,sensitivity,specificity,and predictive values were estimated.Results A series of 2063 high-risk fetuses underwent detailed fetal echocardiography during the study period.The mean gestational age at examination was 26.5 weeks,ranging from 16 to 42 weeks.The most common indications for fetal echocardiography were advanced maternal age(31.7%),fetal arrhythmias (13.5%)and maternal infections(10.4%).Forty-three cases of fetal congenital heart disease were detected.The mean gestational age at prenatal diagnosis was 27.3 weeks ranging from 16 to 40 weeks.There were 3 false-negatives and 1 false-positive.The sensitivity,specificity,positive and negative predictive values were 92.1%,99.9%,97.2%,and 99.8%,respectively.Diagnostic accuracy was 86.1%.A cardiac defect suspected on routine prenatal sonography accounted for the highest proportion of abnormal cases(67.4%).As for pregnancy outcome,there were 24(52.1%)terminations;2.2% died in utero, 13% postnatally,and 28.3% survived.Conclusions(1)Fetal congenital heart disease can be identified reliably by prenatal echocardiography.(2)Possible congenital heart disease or suspected heart defect noted on a screening obstetric sonogram is an important indication for fetal echocardiography.(3)A sequential segmental approach is critical for correct evaluation of the cardiac malformation.(4)The outcome of the patients with congenital heart disease is poor and a multidisciplinary approach is needed to the parental counseling and perinatal management planning.